Leegwater Nick C, van der Meer Sander M, Sierevelt Inger N, Spruijt Hugo, Nolte Peter A
Department of Orthopedics, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands.
Department of Clinical Physics, Spaarne Gasthuis, Hoofddorp, The Netherlands.
J Orthop Surg Res. 2019 Feb 14;14(1):49. doi: 10.1186/s13018-019-1081-5.
The aim of this study was to define deep tissue temperature during cryotherapy in postoperative hip fracture patients, by using measured skin temperature as input parameter for a simple numerical model. Second, an association was investigated between pain and tissue temperature distribution, to assess cryotherapy-induced analgesia of soft tissue-derived pain.
Data from 35 participants in an ongoing trial was used. In three subjects who consented on optional measurements, skin temperature was measured in 3 days during and after cryotherapy. A simple numerical model was developed to calculate tissue temperature distribution during cryotherapy.
Inter and intrasubject skin temperature displayed high variation: trochanter 11-27 °C, mid-femur 11-24 °C, distal femur 10-16 °C. Predicted temperatures decreased to 20 °C at 1 cm, 26 °C at 2 cm, and 30 °C at 3 cm tissue depth. Smallest soft tissue layer was measured at the trochanter; 42% had less than 30 mm and 21% had less than 20 mm. Numeric rating scale pain varied (mean = 2.14; SD = 1.92), and no association was found between pain and decrease in temperature (r = 0.064; p = 0.204).
Cryotherapy was predicted to reduce temperature up to 3 cm; in cachectic patients, this reaches the bone, where it might have implications for bone tissue healing when treated for a prolonged period of time. Cryotherapy-induced analgesia is likely to originate from skin analgesia rather than analgesia of muscle or bone-derived pain.
本研究的目的是通过将测量的皮肤温度作为简单数值模型的输入参数，来确定术后髋部骨折患者冷冻治疗期间的深部组织温度。其次，研究疼痛与组织温度分布之间的关联，以评估冷冻治疗引起的软组织源性疼痛的镇痛效果。
使用了来自一项正在进行的试验中35名参与者的数据。在三名同意进行可选测量的受试者中，在冷冻治疗期间及之后的3天内测量了皮肤温度。开发了一个简单的数值模型来计算冷冻治疗期间的组织温度分布。
受试者间和受试者内的皮肤温度显示出很大的差异：转子处为11 - 27°C，股骨中部为11 - 24°C，股骨远端为10 - 16°C。预测温度在组织深度1厘米处降至20°C，2厘米处降至26°C，3厘米处降至30°C。在转子处测量到最小的软组织层；42%的人软组织层小于30毫米，21%的人小于20毫米。数字评分量表疼痛程度各不相同（平均值 = 2.14；标准差 = 1.92），且未发现疼痛与温度降低之间存在关联（r = 0.064；p = 0.204）。
预计冷冻治疗可使温度降低达3厘米；在恶病质患者中，这会影响到骨骼，长时间治疗时可能对骨组织愈合有影响。冷冻治疗引起的镇痛可能源于皮肤镇痛，而非肌肉或骨源性疼痛的镇痛。
